Fact sheet 7. Big toe deformity and bunion, or stiff toe surgery
The Operation
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There are over 150 different possible operations. Illustrations show surgery carried out with
internal fixation (screws, plates and pins)
Bone cuts are made in the bone to allow correction. The position of the cuts depends upon the
severity of the deformity.
Sometimes two osteotomies will have to be carried out
The bone is repaired using internal fixation not Plaster of Paris. Healing takes place in the
corrected position
Average time for single foot operations = 45 mins.
This practice uses x-rays during surgery to improve the result often know as a c-arm or
fluoroscopy
Aim
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The operative decision is based on extent of deformity, joint damage, length of bone and
quality of bone
To straighten the big toe, reducing the width and pressure from the other toes.
To move the metatarsal inwards to narrow the foot
Shorten the length to reduce joint pressure, pain of impingement and improve the joint
space
To relocate the metatarsal with the sesamoid bones (small pip like bones under the main
bone)
After the operation
Some operations allow faster recovery so
that anything from 2-16 weeks can arise
based on complexity
Post operative pain control guide good to
excellent 95%
Heel weight bearing; no weight taken on
forefoot for up to 4 weeks depending on the
procedure
Success for original problem 80%
Driving 6-8 weeks (average)
A walking shoe is used for 4 weeks.
Sometimes a walking cast made of plastic
can help faster recovery. This will be
discussed if needed
In some cases further surgery is required
to gain additional correction of the
deformity. It is usual to be warned about
this in advance, especially if you are a
young person. Sheet 40 covers common
problems following surgery.
Things you need to know
Some joints are more badly damaged than
others. This may affect the success rate and
joint movement
I will leave this foot to recover for 9-12
months and consider a fusion or replacement
joint if this does not settle
72% can wear shoes by 12 weeks (it is
recommended that you buy new shoes as
your foot will be narrower following surgery)
83% average patient satisfaction rating
Poor walking position will cause foot pain
and affect other joints. Once this is corrected
you will find that your progress will move
quicker. Do not try to rush things
Appliances are not covered by insurers or
NHS and are excluded from the fixed cost
quotations
Colour changes
Incision line healing delay
Transfer metatarsalgia
Painful scar line
Significant stiffness
Numbness along the inside toe
Infection proven
Recurrence
Consultingfoot pain. Podiatric Surgical Services. Mr D R Tollafield 0121-358-2444
12-15%
7%
6%
4%
3%
3%
3%
2%
Fact sheet 7. Big toe deformity and bunion, or stiff toe surgery
Implant /screw problem
Non union of bone
Bone fracture
Abnormal swelling
It is important to massage the scarline
after surgery
2%
1%
0.5%
5%
Scarline pain and sensation loss can be
improved by daily massage x3 for up to three
months
The base wedge osteotomy (sited at end of bone)
This is used for large deformities and provides excellent alignment. Newer fixation techniques
provide reduction of shortening and lower profile than these screws. This technique is used on
healthy bone and has less risk of recurrence. Recovery is longer (6-8 weeks) than some procedures.
Return to work(8-12 weeks). Illustrated below.
The capital osteotomy (Chevron, Austin, Reverdin, Reverdin-Laird-Green, Youngswick) sited
at the top of the bone
The capital osteotomy leaves a smaller incision than many operations
and is designed to decompress joints, offer faster recovery and
generally requires less fixation. Recovery is typically 4-6 weeks and
return to work by 8 weeks. Illustrated right.
Midshaft osteotomy (Scarf-akin) sited in the middle portion of the
bone
This popular procedure amongst foot surgeons offers a wide range of
uses. Recovery is good for large deformities, it is stable but the incision
is longer and stiffening of the joint may take longer to recover than the
capital osteotomy.
Akin (wedged) osteotomy. This is performed in the big toe often with
the metatarsal osteotomy. It will improve tendon alignment and help
straighten the toe position
Consultingfoot pain. Podiatric Surgical Services. Mr D R Tollafield 0121-358-2444